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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 6 (Complete In Triplicate) .......... ...................................•........:.. p Date Issued :.......:.....::....................................... This Permit Expires 1 Year From Oats,Issued ' Application is hereby made to the San Joaquin Local Health District for r a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. .................. jOB ADDRESS/LOC TION CENSUS TRACT .....:............. ... .... Owner's Nam .. -fr.........:.. .................Phone .......... o r i e a Address ........g , .. .....City . . .. . �. ..................... Contractor's Name •..... ..... ....License # .��cZ.. Phone • ... Installation will serve: " Residence•dKortrnertt House(]-Cor-rimercial oTrailer Court Motel ❑Other................ ........................... 3 Garbage Grinder ............ Lot Size .::r..........:::... ��► Number of living units:..__:_f.___ Number of bedrooms ..... -""'-'_........:. w - Water Supply: Public System and name .:. ::...: :........ .........�....... ..:............................Private Character of soil too depth of a feet: Sand tD Silt❑ Clay 0 Peat❑ - Sandy Loam Clay Loam .Hard an . Adobe l D Fill Nlpterlcl :_.'""if yes;type............... ...... (Plot plan, showing size.of 'lot, location of system in- relation to wells, buildings, etc. must be placed 'on reverse aide.} NEW INSTALLATION: (No septic tank or seepage pit permitted If ublie sewer.is available within 200 feet,} PACKAGE TREATMENT. [ ] SEPTIC TANK 14 Size 7 --• ......... � � ........... Liquid�iqu€d Depth .....:... Capacity -� .�_Q- 'Type Material'a-_-C.. .... No. Compartments .�.._.... .. 'Distance to near st: WeU _•---.--.�P - ...........:.Founds#ion ..._!.L?:�'`-..._ Prop. Line ---• �. ............ 41 LEACHING LINE [1] No. of Lines •--..,.` ----------- Length of each line. ........ Total Length ... ........ 'D' Box ......1.-... Type Filter Material ........5.-A.—Depth Filter 'Material .__�: .....----..•-----......1............. Distance to nearest: Well ....... f:_. Foundation -----�_C.. r i' --...... • I��,J+�f- Property Line SEEPAGE PIT Dd' th .................... Diameter ... ......... Number ............................. Rock Filled:.: Yes [) No 0 Water joble Depth --------------------------------------------- --Rack Size ........... -' Qistance to nearest: Well , Foundation _ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# .,_.. _-.•••--------- •--•--- --- Date .......................:..........� Septic Tank (Specify Requirements( i Disposal Field (Specify Requirements) ------------- ........................... ..................................................... ..................................... -----------•----••--- • •---------------------- --------------------•------------- ---- . ----•------ -- -- ---------•- -------------------------.......------------•---•-....---•--....------••-.... ..................................... . (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner of Been- sed agents signature certifies the Following: "I certify that in the performance of the work for"which this permit Is issued, I shall not employ any person in such Manner. i as to become subject to Workman's Compensation laws of California." r ------ Owner I BY 4/1'f -X• `` . Title (if other thawowner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ---------- ------------ ---------- DATE ---Y--.J-�;---2(------------------- t BUILDING PERMIT ISSUED------------ ------ ...................DATE • ------------------.'._. I ADDITIONAL COMMENTS --------------------------------•- ..-..----------.--------...--... k ::::::::::::::::: ::::::::::::::::::::::::::::::::::::.:..:: :: :::::::::::::::::::::::::: _::::::::::::::::::::::::::::: ::::::::::::: ::::: ................... -..A 3...-. ..........-Date Final Inspection b P Y: .... ' Eli 13 2!t 1-68 iiev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M.